This disclosure relates generally to methods and devices for use in performing pulmonary procedures.
When a patient is ventilated in order to perform a surgical procedure, an endotracheal tube is inserted into the airway of the patient. An inflatable cuff or other sealing mechanism is actuated in order to seal the outside of the endotracheal tube to the airway of the patient to prevent air leaks around the tube. The proximal end of the endotracheal tube is connected to the ventilator, and the ventilator is turned on to begin breathing for the patient.
The ventilator performs the inhalation portion of the natural breathing cycle by actively pushing gas into the lungs through the endotracheal tube, and then allowing the natural elastic recoil of the lungs and the chest wall to force the gas out of the lungs during the exhalation portion of the breathing cycle. The physician operating the ventilator—typically the anesthesiologist—can adjust the breathing rate and the tidal volume (volume of gas pushed into the lungs during inhalation), as well as other parameters.
The ventilator can ventilate the patient with any of a variety of gases, such as room air, oxygen of varying concentrations, or when required, gaseous anesthetics such as isoflourane. No matter what gas is used to ventilate the patient, it is important that there are minimal or no gas leaks from the system during ventilation. If there are leaks, the patient is receiving a smaller tidal volume than intended, and if the gas used is an anesthetic, leaks will result in anesthetic gas entering the operating room and possibly affecting the medical staff.
In order to perform bronchoscopic procedures on a ventilated patient, it is necessary to have access to the airway for the bronchoscope and for other instruments and devices. This is desirably done in a way that minimizes or eliminates gas leaks. During a bronchoscopic procedure where the patient is ventilated, the bronchoscope may have to be inserted into and removed from the airway numerous times during the procedure. In order to facilitate this, there are currently anesthesia adapters available that are interposed between the hose leading from the ventilator and the proximal end of the endotracheal tube. These adapters typically contain a flexible elastomeric valve that allows the bronchoscope, usually lubricated with a surgical lubricant, to be inserted into the endotracheal tube (and thus the lungs) to perform a procedure in the lungs. The valve seals around the bronchoscope shaft to prevent gas leaks.
Once the bronchoscope is removed from the endotracheal tube, the anesthesia adapter valve can seal automatically to prevent gas leaks therefrom. Alternately, the anesthesia adapter valve can have a plug or other mechanism that may be manually applied by the operator to stop leaks.
Current anesthesia adapters are designed to allow just a single instrument, such as a bronchoscope, to be inserted into the lungs through the adapter, but are not designed to allow a second instrument or device to be inserted simultaneously. Procedures such as the implantation of bronchial isolation devices such as one-way valves or occluders, the implantation of tracheobronchial stents, etc. can often require at least two devices—such as both the bronchoscope and a delivery catheter, or the bronchoscope and a guidewire—to be inserted into the lungs simultaneously. Given that there a number of procedures that require the insertion of two devices or instruments through an anesthesia adapter into the lungs simultaneously, there is a need for an anesthesia adapter that can accommodate such procedures.